Klebsiella pneumoniae carriage in low-income countries: antimicrobial resistance, genomic diversity and risk factors.
Klebsiella pneumoniae carriage in low-income countries: antimicrobial resistance, genomic diversity and risk factors.
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DOI：
10.1080/19490976.2020.1748257
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发表时间：
2020-09-02
期刊：
影响因子：
12.2
通讯作者：
Brisse S
中科院分区：
文献类型：
--
作者：
Huynh BT;Passet V;Rakotondrasoa A;Diallo T;Kerleguer A;Hennart M;Lauzanne A;Herindrainy P;Seck A;Bercion R;Borand L;Pardos de la Gandara M;Delarocque-Astagneau E;Guillemot D;Vray M;Garin B;Collard JM;Rodrigues C;Brisse S
背景肺炎克雷伯氏菌（Klebsiella pneumoniae，以下简称Kp）是一种主要的公共卫生威胁，导致人类感染的高水平多药耐药（multidrug resistant，MDR）。此外，Kp还在社区中引起严重感染，特别是在亚洲和非洲。虽然大多数Kp感染是由内源性肠道携带引起的，但对无症状人类携带Kp的流行率和微生物学特征以及包括环境源暴露在内的危险因素知之甚少。方法在马达加斯加、柬埔寨和塞内加尔的911名孕妇中进行了Kp肠道定植筛查。定义了Kp菌株的特征（抗菌药物敏感性、基因组多样性、毒力和耐药基因），并调查了相关的风险因素。结果Kp携带率为55.9%，Kp群体具有高度的异质性（6个亚群，325种序列类型，Simpson指数为99.6%）。三分之一的Kp分离株获得了抗菌素耐药基因。MDR-Kp（11.7%-39.7%）和产超广谱β-内酰胺酶（ESBL）的Kp（0.7%-14.7%）因国家而异。检出14.5%携带毒力基因的菌株。环境暴露因素，包括食物，动物接触，或住院的家庭成员与携带Kp，抗菌药物耐药性和高毒力。然而，风险因素具有国家特异性和Kp亚群特异性。结论这项大规模多中心研究揭示了人类肠道携带Kp的巨大多样性，表明抗菌素耐药性在三个低收入国家的社区中广泛存在，并强调了Kp定植对控制抗菌素耐药性所带来的挑战。
Background Klebsiella pneumoniae (hereafter, Kp) is a major public health threat responsible for high levels of multidrug resistant (MDR) human infections. Besides, Kp also causes severe infections in the community, especially in Asia and Africa. Although most Kp infections are caused by endogenous intestinal carriage, little is known about the prevalence and microbiological characteristics of Kp in asymptomatic human carriage, and attached risk factors including environmental sources exposure. Methods Here, 911 pregnant women from communities in Madagascar, Cambodia, and Senegal were screened for gut colonization by Kp. Characteristics of Kp strains (antimicrobial susceptibility, genomic diversity, virulence, and resistance genes) were defined, and associated risk factors were investigated. Results Kp carriage rate was 55.9%, and Kp populations were highly heterogeneous (6 phylogroups, 325 sequence types, Simpson index 99.6%). One third of Kp isolates had acquired antimicrobial resistance genes. MDR-Kp (11.7% to 39.7%) and extended spectrum beta-lactamase (ESBL)-producing Kp (0.7% to 14.7%) varied among countries. Isolates with virulence genes were detected (14.5%). Environmental exposure factors including food, animal contacts, or hospitalization of household members were associated with carriage of Kp, antimicrobial resistance and hypervirulence. However, risk factors were country-specific and Kp subpopulation-specific. Conclusion This large-scale multicenter study uncovers the huge diversity of Kp in human gut carriage, demonstrates that antimicrobial resistance is widespread in communities of three low-income countries, and underlines the challenges posed by Kp colonization to the control of antimicrobial resistance.
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作者：
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DOI：
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